Initial Report From a Swedish High-Volume Transplant Center After The First Wave of The COVID-19 Pandemic.

Felldin, Marie; Søfteland, John Mackay; Magnusson, Jesper; Ekberg, Jana; Karason, Kristjan; Schult, Andreas; Larsson, Hillevi; Oltean, Mihai; Friman, Vanda

BACKGROUND Solid organ transplant (SOT) recipients may be more vulnerable to COVID-19. Data on the clinical course of COVID-19 in immunosuppressed patients are limited, and the optimal management strategy for these patients is yet unclear. METHODS We present 53 SOT recipients (31 kidney, 8 liver, 5 heart, 5 lung, 3 liver-kidney and one kidney-after-heart), transplanted at a Swedish high-volume transplant center and each diagnosed with COVID-19 between February 21, 2020, and June 22, 2020. Demographic, clinical, and treatment data were extracted from the electronic patient files. RESULTS Patients reported fever (61%), cough (43%), diarrhea (31%), and upper respiratory symptoms (29%). The median age was 56 years, and 57% were male. According to severity, 55% had mild, 13% had moderate, 19% had severe, and 13% had critical disease. Thirty-seven patients (70%) were hospitalized, with 8 requiring intensive care. Thirteen of the 37 patients were initially managed as outpatients but later hospitalized. One patient received hydroxychloroquine, and no patients received antivirals. Antimetabolites and calcineurin inhibitors were held or reduced in two thirds. Twenty-seven out of 37 hospitalized patients (73%) received low molecular weight heparin. Five (13,5%) hospitalized patients died. Overall survival for the entire cohort was 94%. No rejection episodes were noted. CONCLUSIONS Hospitalization, lowering of immunosuppression, and prophylactic anticoagulation were the most common therapeutic interventions for SOT recipients with COVID-19. A significant proportion of patients could be managed on an outpatient basis, while keeping a low threshold for admission. Mild and moderate disease forms seems to have good outcome.